Suicide is undeniably a function of psychiatric illness, with well over 90 percent of those taking their lives suffering from a diagnosable mental illness at the time of death. There is little argument among experts that increasing numbers of military personnel, both those with and without combat exposure, are struggling with psychiatric symptoms. The role of deployment and multiple deployments is a bit more complex, particularly given that a considerable number of those dying by suicide have never been deployed. The numbers vary across service branches, but over the last two years, estimates for the Army hover around 25 percent to 30 percent of those dying by suicide have had no deployment history.

Psychological injuries in combat are just as unavoidable as medical casualties.

Regardless of whether a soldier is deployed, the operational tempo of the military during wartime is fast paced and pressure-filled. Soldiers in garrison are in constant preparation for war, meaning more time in the field and less time with family and loved ones. For those that return from combat, it means that when they are home, they’re not entirely at home, as the demands of preparing for the next deployment are considerable. The net result is enormous strain on the system and the individuals who make up that system, including family members and civilian employees. Over the past 10 years, we’ve seen these high levels of stress manifest in progressively higher rates of major depression, post-traumatic stress symptoms and substance abuse, all clearly implicated in the escalating suicide rates regardless of deployment status.

For those with multiple deployments and repeated combat exposure, it is becoming increasingly clear that 10 years of war (with an unprecedented number of soldiers seeing combat two, three and four times) dramatically increases the likelihood of psychological injury. I recently spoke to a Special Forces soldier who has been in Afghanistan nine times over the past 10 years. Regardless of one’s inner strength and resilience, that amount of combat exposure over such a long duration makes post-trauma symptoms almost a certainty.

The Department of Defense has a done a remarkable and admirable job of increasing access to mental health care and combating stigma, work that will change the field significantly for decades to come. Regardless, though, the warrior culture does not embrace psychological injury, with large percentages of those suffering opting not to pursue care. The net result is an increase in personal suffering, high divorce rates, escalating numbers of service members dying by suicide, and families left to grieve tragic and unnecessary losses.

All of us need to recognize and understand that even with the best trained and most effective fighting force in the history of the world, psychological injuries in combat are just as unavoidable as medical casualties. We need to fight stigma, continue to improve access to care, and help those struggling recognize that the answer is reaching out for help.